Friday, October 20, 2017
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Client Questionnaire

If you prefer, you can download Comprehensive Tax Organizer here.

Tax Year:
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Taxpayer Full Name:
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Spouse Full Name:
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Dependent 1 Name:
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Dependent 2 Name:
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Dependent 3 Name:
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Cell Phone:
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Home Phone:
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Best Time To Call:
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Email Address:
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Last Year Tax Returns Available?:
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INCOME
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Total Income Range:
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Wage Statements - Form W-2:
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Pension or Retirement Income - Form 1099-R:
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Interest and Dividend Income - Form 1099-INT/Form 1099-DIV:
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Social Security Income - Form SSA-1099:
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Unemployment Income - Form 1099-G:
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Information on Sales of Stocks or Bonds - Form 1099-B:
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Self-Employed Business Income & Expenses - Form 1099-MISC:
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Lottery or Gambling Winnings - Form W-2G:
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Income and Expenses From Rental Properties:
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Income from Partnerships, S Corp, Trusts or Estates - Form K-1:
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DEDUCTIONS
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IRA Contributions:
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Alimony Paid or Received:
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Child Care Expenses & Provider Information:
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Medical Expenses Over 10% of Annual Income:
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Cash and Noncash Charitable Donations:
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Purchased or Sold Residence This Year:
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Mortgage or Home Equity Loan Interest Paid - Form 1098:
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Real Estate and Personal Property Taxes Paid:
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Job-Related Out of Pocket Expenses:
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Tuition and Education Fees - Form 1098-T:
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Student Loan Interest - Form 1098-E:
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Casualty or Theft Losses:
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LIFE CHANGING EVENTS
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Had health insurance the whole year including dependents:
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Health policy written throgh Healthcare.gov - Form 1095-A:
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Changed jobs:
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Got Married/Divorced during the year:
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Had Foreclosure/House abandonment:
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Had credit card or other debt forgiven/settled:
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Have you given any gifts for over 14,000:
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Shared a household but not married:
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Moved more than 50 miles for job reasons:
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Lived in more than 1 state during the year:
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Received tax notice from IRS/State:
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Received IPPIN from IRS due to identity theft:
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Made energy saving improvements to your home:
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Want to deposit Refunds in the same bank account as last year:
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PLEASE EMAIL ATTACHMENTS TO NICHOLAS AT CPATAXATION.COM OR FAX TO 404-592-6104 (SECURE EFAX)
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